Nurturing innovation in a tough environment

Much has been achieved in the UK in recent years, but the NHS still has a way to go

Innovation has gone beyond being a mere buzzword to a concept that is firmly entrenched in the philosophy of the pharma industry as a whole.

It is the essence of what pharma does - disrupting the current field of medicine with new ways of treating patients - all based on the cutting-edge science that only a multi-billion dollar industry can afford to do.

But within the pharmaceutical industry the very meaning of innovation - and the adoption of novel therapies - has been thrust into the forefront of healthcare discussion in recent months.

There has been much debate concerning the perception from the industry that doctors in the UK, likely influenced by restricted healthcare budgets, are failing to embrace new treatments and utilise them when issuing prescriptions.

You need a company that is progressive, agile and adaptable because our environment is changing as science and diseases evolve

- Ken Jones, Astellas

Shortly after his appointment the new UK life sciences minister, George Freeman MP, said at a meeting in September last year: “I don't think anyone would say the NHS is a catalyst for health innovation. We are still not good enough at adopting innovation into industry, especially within the NHS.”

Little seems to have changed: while speaking at Astellas' 'Innovation Debate' in January, several months after this speech, Freeman acknowledged that the NHS is “on the cusp of a once-in-a-generation chance to maximise the potential of innovation in UK healthcare” - but being 'on the cusp' is a seemingly tacit acceptance that the UK is still not quite there.

The annual Innovation Debate, organised and funded by Japanese pharma firm Astellas, strives to discuss the role of innovation in modern society. For 2015, the debate focused on advances in genetics and electronic technology, and whether they can deliver the promise of personalised medicine.

Ken Jones, CEO at Astellas, is optimistic that innovation is the future of diagnosis, telling PME: “I think everybody, the patients, the clinicians, [and] governments would love it if we could be able to prove our ability to take the guess work away out of healthcare and clinical practice and get better at the precision of prescribing.”

Genomic revolutionLike Freeman, Jones noted that new technologies are evolving and progress is being made in the genomics field. Indeed, the NHS's stance in genomics was widely discussed at the Debate, with the minister for life sciences even going so far as saying the UK is at the “forefront of the revolution”.

Freeman said the government's aim is to make the NHS the first mainstream health system in the world that offers genomic medicine as part of routine care for its patients.

The data compiled using this approach would enable the UK to lead research into new cures for cancer and other genetic disorders, as well as new diagnostics and new uses for existing medicines, according to Freeman.

However, many people have concerns about the ethical implications of collecting DNA information in this way and the minister acknowledged the government and its supporters have a lot to do to get the public on its side.

Without innovation, we risk condemning ourselves to a slow lane of 'Dark Age' medicine

- George Freeman MP, UK minister for life sciences

“If we get it wrong, if we fail to convince patients, the public and the media of the medical benefit [of genomics medicine] we risk condemning ourselves to a slow lane of 'Dark Age medicine',” he said.

The UK's work in the area is led by Genomics England, an organisation set up by the government in 2013. Its main task at the moment is to map the DNA of 100,000 patients with cancers and rare genetic conditions by 2017.

Freeman described the £300m project as the “NASA of genomic medicine” that will allow genomic information to be combined with NHS medical records to create a unique “reference library” for researchers.

“The richness of that dataset can help us understand disease and tease apart the complex relationship between our genes, what happens to us in our lives; our illnesses; our predisposition to different diseases and how different people in this room will respond to the same drug, the same disease in different ways,” Freeman explained.

NHS England has also set up 11 genomics centres in the country to support the '100,000 Genomes Project' by recruiting volunteers.

The project is set to conclude at end of 2017 but Freeman said he believes these centres will help drive UK excellence in genomic research into the future.“When the project ends we want there to be a lasting legacy,” he said.

Better togetherFrom an Astellas perspective, innovation is clearly very high on the agenda, with Jones citing the firm's approach to keeping a respectable balance between what is produced in-house and out, in terms of its collaborations. For Jones, this is 50% each way, he explained.

“As a company, we are looking at innovation as being borderless and we are working in partnerships with different organisations, companies [and] academic areas, so we are following where the science is and going to the experts directly.”

The price of innovation Among the debates around approaches to innovation, there has been much deliberation concerning the most effective way of achieving a successful outcome. Criticism of NICE's lengthy approval process has been pinpointed by some as a dam for the availability of new drugs, but much of the cycle can be aided by the angle that pharma firms take.

But UK pharma feels a little let down in this regard. NICE, England's drug pricing watchdog was to be reformed in order to allow more drugs through its system, but this has been indefinitely delayed.

A new PPRS drug-pricing scheme was introduced in 2014 that was originally designed to add new 'weights' to NICE's decision-making process, but these were deemed by the Institute to be too onerous to implement, and have been effectively discarded.

But the PPRS scheme, which runs for five years, is also designed to help cut the costs of the drugs bill for the UK by ensuring that the UK industry pays back any money it makes over an agreed limit - in 2014 this was around £400m.

This has been somewhat offset by the more than £1bn spent on new cancer drugs rejected by NICE since 2010 that have been funded separately under the Cancer Drugs Fund budget.

But for all non-cancer medicines, many in pharma feel that when an innovative drug is rejected by NICE for its cost, the body is simply failing to take into account the level of research and innovation that was required to create it.

There remains a feeling from the industry that pharma is holding up its end of the deal by paying money back, so the NHS should repay in kind by adopting its new medicines. How to bridge this gap between pharma and NICE continues to be a problem, and there is no easy solution in sight.

Jones concluded by saying that to meet all of the challenges that are thrown at a modern pharma firm: “You need a company that is progressive, agile and adaptable because our environment is changing as science and diseases evolve.

“It is very important as a company that you are able to move resources as quickly as possible depending what trends are there and what discoveries happen in basic research.”